“We Are Already Sick”: Infectious Waste Management and Inequality in the Time of Covid-19, a Reflection from Blantyre, Malawi

Abstract

The efficient and sanitary management of infectious waste is an essential part of the humanitarian response to any disaster, including the ongoing Covid-19 pandemic. Unfortunately, in many contexts within the Global South, waste management systems are poorly equipped to handle these waste streams during periods of normalcy, let alone during times of crisis. The purpose of this article is draw attention to a number of existing inequalities that define infectious waste management practices globally, with a critical eye to how they constrain poorer nations' ability to respond and manage their own Covid-19 outbreaks. In particular, the work draws on the authors' extensive research, experience, and activism at Queen Elizabeth Central Hospital in Blantyre, Malawi, to understand how waste management practices will inform and react to mitigation efforts and to propose a number of practical steps that can be achieved in the short-term, as well as towards long-term structural transformation. Ultimately, this conversation is meant to contribute to a more inclusive and critical waste management studies discourse.

“Everything continued as normal”: What happened to Africa’s wave of Covid-19 waste?

“…How did African nations manage to avoid the Covid-19 waste burden which now litters Northern spaces, and why were waste scholars (including the authors of this discussion, cf. ( Kalina and Tilley, 2020 , Tilley and Kalina, 2020 )) so off in our early predictions for the continent? The most obvious explanation is that African nations, for the most part, have been able to avoid the high levels of Covid-19 infections seen throughout many other parts of the globe.…”

“…Given the magnitude of the crisis and the highly infectious nature of the disease, the sustainable and hygienic management of potentially hazardous waste remains a priority for halting its potential spread- a connection that was made both early and forcefully from many within the interdisciplinary waste management studies field (cf. ( Ilyas et al, 2020 , Nowakowski et al, 2020 , Tilley and Kalina, 2020 , WHO, 2020 ). Moreover, others, including ourselves, expressed concern over a potential avalanche of Covid waste: and not exclusively medical waste, but takeaway containers, plastic bags, empty bottles of sanitizer, and millions of discarded face masks, all generated by a society coping with a new reality of state-mandated consumption and behaviour restrictions (cf.…”

“…Moreover, others, including ourselves, expressed concern over a potential avalanche of Covid waste: and not exclusively medical waste, but takeaway containers, plastic bags, empty bottles of sanitizer, and millions of discarded face masks, all generated by a society coping with a new reality of state-mandated consumption and behaviour restrictions (cf. ( Kalina and Tilley, 2020 , Tilley and Kalina, 2020 )). In an April 2020 discussion in Waste Management, we evoked an image circulating widely on Facebook early in the pandemic of discarded facemasks littering a beach near Hong Kong to highlight the essential role that solid waste management must play in a humanitarian response towards disasters ( Kalina and Tilley, 2020 ).…”

“…Moreover, we also raised alarm over the ability of these emerging waste streams to overwhelm fragile, and potentially overstretched municipal waste management systems, particularly in the Global South (especially Africa) where the waste management sector is under immense pressure even in periods of normalcy, and service and capacity has been structured by grave systemic inequalities: between rich and poor, between the Global North and the Global South (cf. ( Tilley and Kalina, 2020 ).…”

Environmental health practitioners: a key cadre in the control of COVID-19 in sub-Saharan Africa

“…The ever-expanding database of publications related to SARS-CoV-2 also highlights a plethora of areas, both in research and implementation, where EHPs can provide both expertise and generalism and use this opportunity to leverage long-term context appropriate improvements, in what are often neglected areas. For example, (1) the isolation of viral particles in faeces and wastewater highlights the importance of water, sanitation and hygiene programmes to minimise infection transmission 12 13 ; (2) concerns regarding the management of SARS-CoV-2-related healthcare waste, which will require on site treatment 14 ; (3) strengthening control of informal, commercial, institutional and domestic food safety, particularly with regard to meat hygiene, direct consumption of raw produce from markets (which may be in contact with river water contaminated with faeces due to poor sanitation), and the preparation and consumption of street foods (informal vendors) 15 ; and (4) the need for effective health and safety guidance for the assurance of safe work and institutional environments, taking into consideration both physical and mental well-being, including social distancing measures, disinfection procedures, ventilation, and appropriate sanitation and hygiene facility provision. 16…”